01/12/2026
American health insurance is quite possibly one of the worst entities to walk this planet--especially under the guise of "The Greater Good." ๐
A day in the life of your favorite, small-town speech therapist/insurance biller: We took the time to do a benefits check prior to services for a new little one. "No authorization needed for outpatient services." Coo! ๐ฅ
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๏ธ Claim 1: PAID!
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๏ธ Claim 2: PAID!
๐ซClaims: 3-7.... DENIED
Called insurance. Phone rep: "These claims were denied because you did not get prior authorization." ๐ค
After a bit of light-hearted, fun-spirited banter, the phone rep decided I may be onto something when I insisted the benefits check indicated no prior authorization was needed AND the first two claims were paid out.
โณ๏ธHOLD PLEASE โณ๏ธ
The Revelation: Ahh, yes ma'am, I see you are correct in that no prior authorization is required on this member's plan for outpatient services and these claims should have been approved and paid. ๐๐๐๐
Me: ...Right (Internal thoughts: why am I telling you, the people in charge of claims, that you made an error based on your own information and rules, and now I have to prove to you your error and beg for the error to be corrected?!?! ๐ก๐ค๐ก)
โณ๏ธ HOLD PLEASE โณ๏ธ
This poor man now needs to manually reprocess and send back each claim for reprocessing, with notes and attach a form showing that no prior authorization was needed so the claims being denied for lack of prior authorization was an error.
The resolution: Please allow 30 business days for these claims to be reprocessed.
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Mind you these claims were from early NOVEMBER and here we are mid-January.
Moral of the story:
โค๏ธ We love you guys. That's why we take up our sword and shield and go to battle with these insurance monsters.
๐If you receive medical care at a large facility--they aren't making these phone calls. They are sending you the bill and more than likely to collections as by the time they figure it out and send it off they will be 60-90 days "past due."
โค๏ธALWAYS call the billing department and/or insurance claims in charge of your medical bills to ensure all the I's are dotted and T's are crossed.
๐ Know when to push back. This man told me with all confidence the claim was rightly denied. It was only when I, through all power of The Holy Spirit, said with kindness--please confirm that outpatient services need an auth that he changed his tune. THEY DON'T EVEN KNOW THEY'RE WRONG. You have to hop in the Mystery Machine, grab some Scooby Snacks, get the whole gang together and try to go figure out who the man in the mask is.
Plot twist: IT'S THE INSURANCE COMPANY ๐ฆนโโ๏ธ
Gonna go touch grass โฎ๏ธ. Oh wait...it snowed again. ๐ญโ๏ธ